Personal health: 104 teenagers who are role models for weight loss

The problem is undeniable: American children, and especially American teenagers, are fatter than ever. The prevalence of teenage obesity has tripled in the last 30 years, according to Dianne Neumark-Sztainer, the author of "I'm, Like, So Fat." Fifteen percent of teenage girls and boys are overweight, and another 15 percent to 20 percent are at risk of joining them.

Furthermore, wrote Neumark-Sztainer, who studies teenage eating behaviors at the University of Minnesota School of Public Health, dieting has been found to lead to weight gain among teenagers, and more than half of teenage girls and nearly a third of teenage boys use unhealthy weight-control behaviors, like skipping meals, smoking cigarettes, vomiting or taking laxatives.

Enter Anne M. Fletcher, author of the newly published "Weight Loss Confidential," a study of how 104 overweight preteens and teenagers — 41 boys and 63 girls — lost significant amounts of weight and maintained their losses for two years or longer. The average loss was 58 pounds, with 26 of the participants having lost 75 pounds or more and 14 having lost 100 pounds or more. The losses become even more meaningful when you realize that many of the youngsters grew taller as they were losing weight.

When they were questioned by Fletcher, a registered dietitian from Mankato, Minn., these "big losers" had successfully managed their new weight for just over three years on average, with 22 for at least four years and 14 for at least five. So this is not the story of a quick-fix solution to a lifelong problem.

Many of these youngsters had tried fad diets and weight-loss gimmicks, only to regain what they lost and then some. They succeeded only after coming to terms with their self-destructive eating habits and sedentary ways, and making permanent changes in how they deal with food and how they move their bodies.

This survey by Fletcher, who also wrote "Thin for Life," a study of 100 adults who had lost 30 or more pounds and maintained their losses for three or more years, shatters several myths about teenage weight loss, among them that children of overweight parents cannot lose weight.

The adolescents in her book, from across the United States and Canada, lost weight against heavy odds. At least 60 came from overweight families, with 23 having two overweight parents. More than half had been overweight since age 10 or before. Seventy percent said they had lost and regained weight multiple times. Few followed restrictive diets (occasional desserts and fast-food forays were allowed). And nearly all lost weight without developing an eating disorder or adopting some other unhealthy habit like smoking or obsessive exercise.

A look at the reasons the teenagers gave for gaining weight helps in understanding the steps they took to reverse the process. At least three-fourths of the youngsters listed "too much snacking," "portion sizes too large" and "not enough exercise" as their main reasons for weight gain. Other reasons checked by at least one-quarter of the participants were "ate too many sweets and desserts," "emotional causes like eating when lonely, bored or sad," "spent too much time in front of the TV, computer, and/or video games," "ate too much fast food," "it runs in my family" and "too many fattening foods served at home."

Fletcher does not necessarily blame parents for their children's weight problems. After all, one of the study participants was her son Wes, who said that part of the problem was that his parents did everything "right." But clearly many families needed to make changes in the foods they bought, how they cooked, how food was served and where they ate.

Most important, though, was a change in how the youngsters felt about their weight and about the role that food and exercise (or lack thereof) played in their lives.

Fletcher was surprised that health was cited as often as appearance in deciding once and for all to lose weight.

"My main concern was to become healthier," said Taylor S., who once weighed 250 pounds and lost 100 pounds over two years. "I didn't want to die in my 40s because of my eating habits."

Angel W., who had high blood pressure when she weighed 240 pounds, brought it down to normal without drugs by losing 65 pounds.

Of course, appearance mattered a lot to these teenagers, many of whom wanted to be more attractive to the opposite sex and be able to wear fashionable clothes. Improving self-esteem and being free from teasing and ridicule were other common motivations for weight loss.

And about a quarter of the participants said their weight was holding them back from doing what they wanted, including participating in sports.

Fletcher warns that to succeed at lasting weight loss, teenagers — like adults — have to be truly ready to come to grips with their weight problem. She quotes Sari M.: "Unless you want to do something about your weight for good reasons, you probably won't stick with it.

If you're happy with the way you look — or you're not unhappy enough with it to do something about it — then let it be. You'll only feel worse about yourself afterward if you don't succeed."

Over and over, the teenagers told Fletcher that the motivation had to come from within. Nagging by parents or nasty comments from coaches only prompted many of the youngsters to eat more.

The study participants took one of two routes to weight control: 49 slimmed down on their own, and 52 succeeded with the help of a health care professional (usually a dietitian) or a program (such as a summer camp for overweight teens, Weight Watchers or TOPS). Two in this group who had serious weight-related health problems underwent bariatric surgery to correct their obesity. Three others started losing on their own, then joined a program to reach their goals.

Leading the pack of slimming strategies was exercise or becoming more active, listed by 86 of the participants as their main route to a healthier weight. The most popular activities were running, walking and lifting weights. Next was cutting back on high-fat foods, listed by 48; going on a diet, 47; cutting out certain foods, 42; counting calories, 29; eating all foods, but less of them, 26; skipping meals, 14; using a liquid supplement or energy bar as a meal replacement, 11; using weight-loss drugs, 5; fasting, 3; and smoking cigarettes, 1.

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All the successful losers restructured their eating habits. They learned to eat when they were hungry and to stop eating when satisfied. Dishing up smaller portions, eating filling foods that were low in calories and eating fewer foods high in fat were popular strategies.

Many avoided a sense of deprivation by allowing themselves a treat now and then. When out with friends, they tried to choose foods that were healthier and less caloric. Although relatively few counted calories, many started reading nutrition labels and became more aware of the caloric and nutrient value of the foods they regularly ate.

Keeping off the weight they lost was sometimes harder than losing it. Strategies included exercising regularly; weighing themselves weekly and cutting back if they gained; learning more about nutrition; and paying closer attention to biological — as opposed to psychological — hunger.

Anne M. Fletcher devised a readiness check for teenagers who are contemplating weight loss. Each question can generally be answered with "very," "sort of" or "no/not very."

1. How concerned am I about my weight?

2. How much do I want to do something about my weight right now?

3. How confident am I that I can do something about my weight?

4. Do I think I can do something about the things that are getting in my way?

5. How ready am I to change my eating habits?

6. How ready am I to become more physically active?

7. Is my family ready to support me in my efforts?

The more answers in the "very" column, the more likely a teenager is ready to turn things around. As Emily B. put it, "It's a matter of thinking about what's more important — eating super-sized French fries or feeling better about yourself."

Most teenagers who lose a significant amount of weight and keep it off require the encouragement and cooperation of their parents, Anne M. Fletcher found in her study of 104 adolescents who did just that.

Criticism and nagging proved counterproductive. Comments like "Haven't you had enough?" or "Are you really going to eat that?" from a concerned parent often resulted in defiant behavior, Fletcher found. Rather than hearing critical remarks, teenagers struggling with weight problems need to be admired for their achievements, encouraged for trying and loved without question.

One mother interviewed by Fletcher emphasized the importance of teenagers having "ownership" of their efforts.

"If a child is constantly relying on someone who says, 'Don't eat this' or 'Don't eat that,' it doesn't work," the mother said.

Instead, this mother asked her son in various situations whether he wanted her to point out to him how much he was eating. If he said yes, they established a signal to use between them.

There are many steps parents can take to help young people trying to lose weight, Fletcher found. They can shop with better nutrition in mind, avoiding high-fat processed foods and meats, and prepare more vegetables and salads with low-fat or fat-free dressings. Snacks like chips and ice cream are best bought in single-serving packages. If the household must stock high-calorie snacks, they should be kept out of sight.

Fresh fruit should always be available. Consider having a fruit salad and cut-up vegetables with a low-fat dip immediately obvious when the refrigerator is opened.

No sugar-sweetened soft drinks allowed! If other family members insist on having soda, the sugar-free ones can be kept on hand, but should be drunk only in moderation. Water was the beverage of choice for the teenagers who lost weight. Skim or 1-percent milk is also helpful, especially because weight loss is often accompanied by bone loss.

Whole-grain breads and cereals should predominate in the home; in addition to being more nutritious, they are more filling.

Many youngsters in Fletcher's study got help from parents who joined them in a weight-control program or participated with them in a physical activity, often to the parent's benefit as well. Having regular family meals was also cited as helpful. And no child, especially not one trying to lose weight, should leave home without breakfast, even if it is eaten on the way to school.